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Tình trạng thiếu kẽm và một số yếu tố liên quan ở phụ nữ có thai tại thành phố Hồ Chí Minh

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Tình trạng thiếu kẽm và một số yếu tố liên quan ở phụ nữ có thai tại thành phố Hồ Chí Minh

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Mục tiêu: xác định tỉ lệ kẽm và các mối liên quan ở phụ nữ có thai tại Tp. Hồ Chí Minh. Đối tượng và phương pháp: Một điều tra cắt ngang được thực hiện trên 700 phụ nữ có thai tại Tp. Hồ Chí Minh năm 2007. Đối tượng được cân, lấy máu xét nghiệm kẽm. Thiếu kẽm ở phụ nữ có thai được chuẩn đoán khi kẽm huyết thanh < 56Mg/dl ở ba tháng đầu,

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Nội dung Text: Tình trạng thiếu kẽm và một số yếu tố liên quan ở phụ nữ có thai tại thành phố Hồ Chí Minh

  1. TC.DD & TP6 (3+4) - 2010 TINH TRANp THIEU KEM VA MOT SO YEU TO , LIEN QUAN O PHU NU" CO THAI TAI T H A N H PHO HO CHI MINH Nguyen Thanh Danh', Trdn Thi Minh Hanh ', Phan Nguyen Thanh Binh\ Nguyen Nhdn Thdnh ^ Le Thi Kim Qui' Muctieu;Xac dinh ti le thieu kem va cac moi lien quan d PNCT tai TP.HCM. Doi tugng va phuong phap; Mgt dilu tra cat ngang dugc thuc hien tren 700 PNCT tai TRHCM nam 2007. Doi tugng dugc can, liy mau xet nghiem kem. Thieu kem d PNCT dugc chan doan khi kem huyet thanh < 56 pg/dl d ba thang dau, < 50 pg/dl d 3 thang giira va 3 thang cuoi. 700 PNCT dugc phong van thong tin ve kien thiic phong ngira thieu kem, tinh trang nghen va nhdm nhd 341 PNCT dugc chon ngau nhien de phong van che do an 24h. Ket qua: 39,6% PNMT cd ham lugng Zn huyet thanh thap, ti le thieu kem d ngi thanh va d ngoai thanh ngang nhau (39,4 & 39,8%); ty le thieu kem cua PNCT d ca 3 thai ky cao ngang nhau (40,0% d 3 thang dau, 37,6% 3 thang giua va 40,5% d 3 thang cuoi). Khau phan PNCT c6 nang lugng thap, nhat la d 3 thang dau va giiia, chi dat 78,6% va 80,6% so vdi nhu cau khuyen nghi ciia Bg Y te. Nghen xuat hien chu yeu vao 3 thang dau (63,0%), thang thii nhat la 38,1%, thang thii hai la 21,0%, thang thii 3 la 3,4%. Miictieuthu nang lugng va protein ciia nhiing ngudi nghen thap hon nhiing ngudi khong nghen (31,8 ± 11,3 so vdi 39,2 ± 14,1 Kcal/kg/24gid, p
  2. TC.DD & TP6 (3+4) - 2010 dai tre sd sinh, cham phat trien tam vdc Tieu chuan chgn mau: Phu nii cd va tri tue cua tre sau nay, ddng thdi lam thai cU ngu tai TP.HCM tii luc mang giam kha nang dap ting midn dich va thai de'n thdi diem khao sat, bie't rd tang nguy cO mac cac benh nhiem tning ngay kinh cud'i, ddng y tham gia [2,4]. CIc ket qua khao sat d phu nii cd nghien ctiu. thai tai mdt sd' vung ndng thdn Bac Ninh Tieu chuan Ioai triif: Khdng bie't va Ha Tay cho thay ti le kem huyet ngay kinh cud'i, tu' cbd'i tham gia thanh thap chiem 30-60% [4-6]. Mat nghien ctiu, bi benh nhiem trung cap khac, thieu kem d cac ba me cd thai cd hoac man tinh nhu benh tim, suy the gay nghen [7] la mdt yeu td lam ban than, benh Ic tinh; benh cua he tao che cung cap nang lugng va cac chat dinh mau. Mau huyet thanh xet nghiem dudng cho PNCT. Tinh trang nghen va kem bi lan bong cau. Budn ndn va giam an 6 cac ba me mang thai trong 3 ndn do cac benh khac nhu benh viem thing dau chie'm ti le rat cao. Cd tiii mat, benh vien tuy cap... khoang 75-80% ba me cd thai bi nghen, bieu hien bdi trieu chung budn ndn hoac Ky thuat chgn mau: Mau dugc ndn miia [8-9], neu nang va keo dai cd chgn theo phuang phap ngau nhien the gay anh hudng rat ldn de'n sU phat PPS (Probability proportional to size). trien ciia bao thai, the hien qua su cham Cdng thtic tinh cd mau de Udc lUdng tang can d thai phu trong 3 thing dau. ti le thieu kem dUdc tinh nhti sau: n Mat khic, tinh trang nay cdn l l m giam = Z2p(l-p)/d2 vdi Z=l,96; d =0,05, n = sU tich luy ning lUdng, cd the gay nen 323, P=0,30 [4-6]. Udc tinh ti le bd tinh trang giam tiet siia me sau sinh va cugc la 10% nen tdng so' dd'i ttidng mat siia sdm d cac ba me. can dUdc khao sat tinh trang thilu kem la 718 PNCT. Do tam quan trgng cua van de neu tren, chiing tdi tie'n hanh nghien cu'u dl Danh gia nang lu"rfng khau phan: n tai vdi muc tieu: " Danh gia thuc trang = (Za)VA2 v&i Z= 1,96, A = 250, a thieu kem va tim hieu mot so yeu to = 2234 (Ndng luang tieu tht.1 trung Uen quan a phu nii' co thai tai thanh binh d PNCT tudn 16-22) [10]. Udc phi H6 Chi Minh" tinh ti le bd cugc la 10% nen tdng so' dd'i tUdng can dtidc khao sat khau II. DOI TLTOTVG VA P H L T O N G PHAP phan la 341 PNCT. NGHIEN Ctru Phtiofng phap thu thap so' lieu: 1. Doi tu'O'ng nghien cuu Khau phan dUdc dieu tra bang Phu nir cd thai sinh sd'ng tai 30 phudng phUdng phap nhd lai 24 gid va phdng xa thugc ndi tbanb va ngoai thinh van tan sua't thUc pham. Phdng van TP.HCM nam 2007. mgt so' ye'u td' lien quan dtia vao 2. Phuong phap nghien cuu bang cau hdi soan san. Sti dung can dien tti TANITA sai so' 200g de can - Phticfng phap nghien ciiu: nghien PNCT. Kem huyet thanh dUdc phan Cliu md ta cat ngang. tich bang phUdng phap cUc phd (Po- 49
  3. TC.DD & TP6 (3+4) - 2010 larography) tai labo ciia tmdng Dai kcal/ngay [14]. hgc khoa hgc tti nhien. 3. Phrforng phap xuT Iy so lieu: Tieu chuan chan doan va danh gia: So lieu dtidc nhap b a n g phan Nghen dtidc dinh nghia la tinh trang m e m EPI-INFO 6.0 va xti ly bang budn ndn vl ndn hole chin an, an it phan m e m Stata 8.0. So sanh cac xay ra khi mang thai, dac biet la 3 ti le bang test x2 va so sanh cac thing dau, xay ra bat ky thdi gian gia tri trung binh bang T-Test. Gia nao trong ngay hay dem [11,12]. tri p < 0,05 dtiOc xem 1 co y nghia Thieu kem dugc chan doan khi kem tho'ng k e . huye't thanh < 56 pg/dl 6 la < 5aO III. KET QUA NGHIEN ClTU pg/dl d 3 thing giua va cudi [13]. Ning lUdng thie'u so vdi nhu cau I. Cac dac diem dich te va Iam sang khuyin nghi cho PNMT khi < 2450 ciia phu nu- co thai tai TP. HCM Bdng 1. Dac diem djch te va nhan trac cua doi tu'ong Toan bo 3 thang dSu 3 thang giira 3 thang cuoi n(%)' n(%) n(%) n(%) Noi cu ngu Noi thanh 401 (57,3) 22(3,1) 130(18,6) 249 (35,6) 0,006 Ngoai thanh 299 (42,7) 3 (0,4) 96(13,7) 200 (28,6) Nhom tuoi • . : - . . . • 40 8(1,1) 0 (0,0) 4 (0,6) 4 (0,6) TONG SO n=700 25 (3,6) 226 (32,2) 449(64,1) Khao sat 700 phu nii cd thai tai TP. 2. Phan bo phu nu co thai theo ti le HCM cho thay ti le phan bd cua mau thieu kem theo khu vuc va thoi gian dugc chgn khdng ddng deu: 3 thing dau mang thai va dudi 20 tadi cd ti le thap, nhat la vung Ti le thieu kem d ddi tagng khao sat ngoai thinh, ti le cao d 3 thing cudi rat cao (39,6%), ti le nay phan bd deu cho (64,1%) vl tadi tap trung cao nhat la 20- ca 2 khu -virc ngi va ngoai thanh va cic 39 tadi la 85,6%. giai doan mang thai (Bang 2). 50
  4. TC.DD & TP6 (3+4) - 2010 Bang 2. Ti le thilu kem ciia PNCT theo 3 giai doan cua thai ky. TI LE THIEU KEM Giai doan mang thai Khu vuc Chung n (%) 3 thang Dau 3 thang Giua 3 thang Cuoi n (%) n (%) n (%) Noi thanh 401 158(39,4) 8 (36,4) 47(36,2) 103 (41,4) 0,3 Ngoai thanh 299 119(39,8) 2 (66,7) 38 (39,6) 79 (39,5) TS 700 277 (39,6) 10(40.0) 85 (37,6) 182(40,5) n = tdng sd thieu kem, %= ty li thiiu kem Ham lugng kem huyet thanh trung binh cd xu hudng giam dan khi tadi thai tang len nhung khdng cd y nghia thdng ke do do lech chuan ctia kem trong nghien ciiu nay khi ldn. Bdng 3. Dac diem ve tieu thu. nangluong,proh jin va tang can ciia doi tucmg* Thoi gian Mang thai Dac diem Toan bo P 3 thang dau 3 thang giii'a 3 thang cuoi Kem trung binh n =700 n = 25 n = 226 n = 449 0,7 62,0 ±21,9 60,2 ±19,8 59,4 ± 19,5 n = 325 n = 10 n=107 n = 208 Nang lugng (Kcal)/ngay 1925 ±1247 1975 ± 647 2211 ±768 0,02 Protein (g)/ngay 72,7 ±47,1 81,5±31,0 93,8 ±43,3 0,015 Tang can (kg)* * 1,4 ±3,3 4,5 ± 3,5 9,4 ±3,9
  5. TC.DD & TP6 (3+4) - 2010 Bang 5: Tieu thu nang luong, protein va ty le thieu kem ciia cac doi tuong dang nghen trong nhom CO khao sat khau phan tir thang thii-1 den thang thir 4. Nghen Chl so Co Khong P n = 30 n=163 Tieu thu nang lugng (Kcal/kg/24gi6) 31,8 ± 11,3 39,2 ± 14,1 0,01 Tieu thu protein (g/kg/24gid) 1,3 + 0,6 1,7 ± 0 , 8 0,04 Protein Dv/Ts protein 0,55 ±0,16 0,56±0,17 0,7 Ty le thieu kem (%) 33,3 38,7 0,6 PNCT cd tinh tiang nghen co muc tieu thu nang lugng thap ban 19% va protein thap hon khoang 23,5%o so vdi nhiing ngudi khong nghen. Bang 6: Lien quan giCfa thie'u kem va nghen n TINH TRANG THIEU KEM OR CI.95% P Thieu n (%) Khong n(%) Co 30 10(33,3) 20(66,7) Nghen ,26 0,55-2,78 0,6 Khong 163 63 (38,7) 100(61,3) Ting 193 73 (37,8) 120(62,2) Khdng cd mdi lien quan giua tinh trang nghen va thieu kem. Bang 7 : Kien thufc ve nguonthyc phamchufa kem 3 thing dau, nhat la mdi cd thai trong STT Thuc an % thing dau rat khd xac dinh chac chan va 1. Hau 13 1,9 thu'dng chua di dang ky khim tai dia phuang nen khdng the lap danh sach day 2. Thiic an co nguon goc dong vat 42 6,0 du de dua vao nghien ciiu. Vi the, toln bg 3. Thiic an khac 27 3,9 sd mau tay chgn du ve mat ly thuyet 4. Khong bigt 618 88,3 (98%) nhung phan bd khdng ddng deu, TS 700 100 chu yeu d 3 thing giiia va cudi. Dieu niy cd the tao ra sai sd nhat dinh do lam giam Hau het cic b l me thieu kien thu'c ve thu'c sd mau dai dien cho ddi tagng la PNCT an giiu kem. tiong qui dau v l lam tang sd mau dai dien cho cic PNCT tiong 2 qui cdn lai d ca hai IV. BAN LUAN khu vuc ngi vl ngoai thinh. Sd PNCT tap Mau dugc chgn theo phuong phap trung d do tali tii' 20-39 tadi (93,3%). Chi ngau nhien theo cum de cd the dai dien sd khoi CO the (BMI) trung binh tru'dc klii cho PNCT dang sdng tai cac vung sinh mang thai cua ele ddi tagng d 3 giai doan thii d ngi va ngoai thanh thanh phd Hd mang thai d muc trung binh thip v l tang Chi Minh, nhung do nhiing PNCT trong can trung binh d ca 3 ky thai cung chi dat 52
  6. TC.DD & TP6 (3+4) - 2010 d muc tmng binh va cd do lech chuan kha Ket qua khio sit khau phan ldn. Dieu nay the hien su tdn tai cua tinh PNCT cho thay gil tri sinh nang lugng trang thieu dinh dudng trudng dien cua thap, nhat la d 3 thing dau va giu'a, chi nhieu ddi tagng trong nhdm nghien cun dat 78,6% vl 80,6%) so vdi nhu cau (bang 3). Trong nlidm nghien ciru cd den khuyen nghi cua Bd Y te. Keo theo cung 39,6% sd PNCT cd ham Iugng Zn huyit cap protein thap d 3 thing dau va giua ( thanh thap, the hien tinh trang thieu kem bang 3). Thinh phan thu'c an cua PNCT d PNCT tai TPHCM rit cao, day 11 mdt kha da dang, bang thanh phan dinh dudng van de sue khde cdng ddng rat dang dugc thu'c an Viet Nam cd nhieu thuc pham bao dgng nhu tinh trang thieu kem d cac chua cd thanh phan kem nen chung tdi nudc dang phat trien hien nay [2,3], ti le khdng the tinh dugc ham lugng kem nay tuong duong vdi cic ket qua khao trong khau phan trong nghien ciiu nay sit 5 phu nii cd thai tai mgt so' vung nhung lugng protein trong khau phan ctia ndng thdn Bac Ninh va Ha Tay (30- nhiing PNCT d 3 thing diu va PNCT bi 60%) [5-6], trong dd ti le thieu kem d nghen thap so vdi nhu cau khuyen nghi PNCT ndi thanh va PNCT d ngoai thanh ctia Bd Y te ^'"'^ day cd the la mgt yeu td ngang nhau, du muc sdng d PNCT ngi gdp phan gay thieu kem d PNCT - ddi thanh thudng kha ban nhung van chua cd tagng cd nhu cau kem dang gia tang. Mat sir cli thien ve tinh trang kem so vdi khac, tinh trang nghen xuat hien vdi ty le PNCT d ndng thdn. Kem trung binh cd rat cao trong 3 thing dau la 62,5% vdi xu hudng thap dan va thap nhat d 3 thing muc tieu thu nang lugng thap ban khoang cudi nhung ti le thieu kem theo thdi gian 19% va protein thap ban khoang 23,5%) mang thai d cic 3 thing dau, giua va cudi so vdi nhiing ngudi khdng nghen, dieu cd ty le cao ngang nhau, dieu nay do cleh nay cd the la mdt yeu td gdp phan gay chgn tieu chuan chan doan thieu kem cho thieu kem va thieu nang lugng rat dang 3 thing giiia va cudi thap hon (< 50 mg/dl luu y d PNCT . Thieu kem cd the gay ra mdi dugc coi la thieu kem). Trong khi dd tinh trang budn ndn [7], the hien tinh nghien ciiu d ngoai d bang Haryana An trang nghen d ddi tugng nay, cung nhu do nam 2001 cd 64,6% thieu kem vdi tieu tinh trang, chan an, an it the hien bang chuan chan doan thieu kem khi ham tinh trang suy giam tieu thu nang lugng lugng kem huyet thanh < 66pg/dl [15], va [18], nhung tiong nghien ciiu nay chting mgt nghien ciiu md ta phan tich tren 400 tdi chua tim thay mdi lien quan giiia tinh PNCT den kham tai benh vien Zebedan tiang nghen va thieu kem, ty le thieu kem Ghods cua Iran cd 49% thieu kem vdi d nhdm cd tinh trang nghen thap ban tieu chuan chan doan thieu kem khi ham nhdm khdng nghen nhung khdng y nghTa lugng kem huyet thanh < 70pg/dl [16]. thdng ke, cd le do sd mau trong nhdm cd Nhu vay, neu sti' dung tieu chuan chan tinh trang nghen trong 4 thing dau cua doln thilu kem theo cic tieu chuan da su' ddi tugng nghien cun cdn thap. Mat dung trong cac nghien cuu nay thi ti le khic, hau bet PNCT khdng cd kien thuc thilu kem d PNCT tai TP HCM cao ban ve thu'c an giau kem la ly do rat ding rat nhieu. quan tam trong viec tim hieu nguyen 53
  7. TC.DD & TP6 (3+4) - 2010 nhan gay ra tinh trang thieu kem d PNCT. 5. Huong CTT, Khan NC, Ninh NX. Tinh Nhiing y i u to tren cd the tao ra mgt vdng hinh thieu mau, thieu vitamin A, thieu luin quin gay bat lgi cho sue khde ctia kem 5 phu nU co thai huyen Thanh Oai, PNCT va su p h i t trien cua bao thai. Ha Tay & mgt sd yeu td anh hudng. Tap chi Y hgc thUc hanh. 2003; 453(5); V. KET LUAN 16-18. • Thilu kem d PNCT van 11 van de cd y 6. D 5 Thi Kim Lien, Nguyen Xuan Ninh, nghia sue khde cdng ddng tai TP.HCM, Nguyen Thi Lan Anh, Nghiem Nguyet ty le thilu kem d PNCT nam 2007 la Thu. Budc dau tim hieu tinh trang thieu 39,6%, ti le thilu kem d ngi thanh v l d mgt so' yeu to' vi lUOng tren phu ni? co ngoai thanh cung nhu ty le thieu kem cua thai. Tap chi Y hgc dU phdng. 1999; 9 PNMT d 3 giai doan mang thai gan taang (4);57-61. duong nhau. 7. Pfeiffer C. C , Gonthier P. (1988), Muc tieu thu nang lugng va protein trong "Anemie ferriprive". Dans ; Equilibre 3 thing dau va 3 t h i n g giua cua PNCT psycho-biologique & Oligo-elements, thap so vdi nhu cau khuyen nghi va tinh Equilibres aujourd'hui. Editions equi- trang giam tieu thu nang lugng va protein libres, pp. 332-333. do nghen va thieu kien thuc ve thuc pham giau kem cua PNCT cd the la nhung yeu 8. New study finds morning sickness dmg td gdp phan gay ra tinh trang thieu kem d metoclopramide (Reglan) safe during ddi tagng nay. pregnancy (lune 13th, 2009). (http ;//w WW. examiner.com/sf-in-san- TAI LIEU THAM KHAO francisco/new-study-finds-morning- 1. Parul Christian. Micronutrients and re- sickness-dmg-metoclopramide-reglan-sa productive health issues: an interna- fe-during-pregnancy). tional perspective. J. Nutr. 2003; 133: 9. Morning sicimess during pregnancy- 1969S-1973S. remedies and cures (3/2009). 2. Shah, D. & Sachdev, H.P.S. Effect of (http;//www.pinkfridge.com/lal_preg- gestational zinc deficiency on preg- nancy/moming-sickness. htm). nancy outcome; summary of observa- tional and zinc supplementation trials. 10. Cao Thi Thu HUdng, luliawati Untoro, Br.J.Nutr. 2001; 85: S101-S108. Werner Schultink, Nguyen Cdng Khan, Ha Huy Khoi. Hieu qua ciia viec bo 3. Parr, R.M.Assessment of dietary in- sung da vi chat len tinh trang dinh takes. In: Trace elements in human nu- dudng ciia phu nCf co thai. Mgt so'cong trition and health. World Health trinh nghien cu'u ve dinh dUdng & ve Organization, Geneva, Switzer- sinh an toan thtfc pham. Vien Dinh land.1996; 265-288, DuEing. NXB Y hpc. Ha ngi. 2000; 114-126. 4. King, I. Determinants of matemal zinc 11. Morning Sickness (3/2009). status during pregnancy. Am. I. Clin. (http;//www.healthscout.com/ency/68/2 Nutr. 2000; 71; S1334-S1343. 30/ main.html#DefinitionofMom- 54
  8. TC.DD & TP6 (3+4) - 2010 ingSickness) women in arural block of Haryana state, India. Asia. Pac J Clin Nutr 2008: 12. Morning Sickness 17(2);276-279. (3/2009).(http;//www. encyclopedia.CO m/doc/lG2-3435100536.html.) 16. Salimi, Yaghmaei, loshaghani and Mansourian. Study of zinc deficiency 13. Christine Hotz, lanet M Peerson. Sug- in pregnant women. Iranian i Publ gested lower cutoffs of serum zinc con- Health, 2004, Vol.33, No.3,pp.l5-18. centration for assessing zinc status; reanalysis of the second National 17. Cousins R.J. (1996), "Zinc". In; Present Health and Nutrition Examination Sur- Knowledge in Nutrition, T^ Ed., ILSI vey data (1976-1980). American lour- Press, Washington, DC, 29, pp. 296-302. nal of Clinical Nutrition, 18. Nguyen Thanh Danh, Ta Thi Anh Hoa Vol.78,No.4,756-764, October 2003. va Cs (2003), "Tac dung cua bo sung 14. Vien Dinh Du8ng. Bang nhu cau dinh kem len tinh trang suy giam tieu thu dudng khuyen nghi cho ngUdi VN. 2003. nang lugng va cac roi loan di kem d tre em 3-48 thang ", Tap chi Y Hgc Thuc 15. Priyali Pathak, Umesh Kapil, Sada Hanh. Hgi Thao Nhi Khoa Viet Phap Nand Dwivedi and Rajvir Singh. Lin Thii 3 Tai Hul (16-17/04/2003), Bg Serum zinc levels amongst pregnant Y Tl, Ha Ngi, s l 449, tr.34-41. Summary ZINC DEFICIENCY AND RELATED FACTORS IN PREGNANT WOMEN IN HOCHIMINH CITY Objective; To identify the rate of Zinc deficiency and related factors in pregnant women in HCM city. Meth- ods: Across sectional survey was conducted among 700 pregnant women in HCM city in 2007. The subjects were weighted and their blood was taken for Zinc analysis. Zinc deficiency in pregnant women was iden- tified when blood Zinc < 56 pg/dl in the 1 st trimester and < 50 pg/dl in the 2nd and 3rd trimester. Interviews were taken to collect data on knowledge on Zinc deficiency control, and morning sickness. A sub-group of 341 pregnant women was randomly selected to collect 24-hour dietary recall. Results; 39.6% of the pregnant women had Zinc deficiency, this rate was the same ui urban and sub-urban area (39.4 and 39.8%); Zinc de- ficiency were at the same rate in 3 trimesters (40.0% in the 1st, 37.6% in the 2nd and 40.5% in the 3rd trimester). Pregnant women had low energy intake, particularly in the 1st and 2nd trimester, meeting only 78.6% and 80.6% of the Vietaam RDA. Morning sickness mostly appeared in the 1 stttimester(63.0%), of which 38.1% in the 1 st month, 21.0% in the 2nd month and 3.4% in the 3rd month. Energy and Protein in- take of those women was lower than that of those without morning sickness (31.8 ± 11.3 vs. 39.2 ± 14.1 Kcal/kg/24hours, P

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